Provider Demographics
NPI:1528507381
Name:BULLOCK, BRITTANY KIERA (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:KIERA
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 COURTNEY CREEK BLVD
Mailing Address - Street 2:APT. 1135
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-1691
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2850 COURTNEY CREEK BLVD
Practice Address - Street 2:APT. 1135
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-1691
Practice Address - Country:US
Practice Address - Phone:919-244-4159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0106911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical